Abrasion vs. Attrition
This type of wear often presents as a smooth, even wearing down of the tooth surface.
What is attrition?
What is the hardest substance in the body, which forms the outer layer of the tooth crown?
What is enamel?
This type of fracture appears as fine cracks or "tiger stripes" in the enamel and typically does not require treatment
What is an enamel infraction?
This type of pulpitis is caused by short-term irritation and can be reversed if the irritant is removed.
What is reversible pulpitis?
What is the layman's term for periapical pathology?
What is a tooth root abscess?
This type of injury involves the tooth being partially displaced from the socket, often at an angle, and is usually associated with a fracture of the alveolar bone
What is a lateral luxation?
What is the name for a lesion that develops when periodontal disease progresses to the point of affecting the pulp?
What is a perio-endo lesion?
Cage or fence chewers often exhibit this type of wear on the distal aspect of their canine teeth
What is abrasion?
Composed of collagen fibers and hydroxyapatite crystals, this structure lies beneath the enamel and contains dentinal tubules.
What is dentin?
A client calls, frantic because their dog just broke a tooth while chewing on a bone. They describe seeing a pink spot in the center of the fractured tooth. What type of fracture is this most likely to be?
What is a complicated crown fracture?
What clinical sign is highly suggestive of pulpitis, especially following trauma?
What is a pink discoloration of the tooth?
What radiographic findings are suggestive of periapical pathology?
What are widening of the periodontal ligament space, periapical lucency, and root resorption?
What is the term for a tooth that has been completely knocked out of the socket?
What is an avulsion?
You are examining a dog with advanced periodontal disease and notice a draining tract near the root of a molar. What should you suspect?
What is an endo-perio lesion (periodontal disease leading to endodontic disease)?
You notice a dog has wear on the palatal aspect of its upper canine teeth. What is the most likely cause?
What is attrition due to a malocclusion?
What structure sits at the interface of the dentin and pulp and is responsible for producing dentin throughout the life of a tooth?
What are odontoblasts?
What is a "slab fracture"?
What is a type of crown-root fracture in which the buccal wall of the tooth shears away, often leaving a mobile fragment?
A dog presents with a discolored canine tooth after being hit in the mouth with a ball two weeks ago. The owner reports that they have been giving the dog carprofen as prescribed. You re-examine the tooth and note it is still pink. What type of pulpitis does this dog have?
What is irreversible pulpitis?
A dog presents with a history of chronic nasal discharge. You suspect a dental problem may be the underlying cause. Radiographs reveal a retained root tip from a previously fractured maxillary canine tooth. The root tip is surrounded by a lucency extending into the nasal cavity. What is the most likely diagnosis?
What is a periapical cyst?
A playful Labrador puppy presents after colliding with a coffee table. You suspect a dental injury. Oral examination reveals one incisor that appears shorter than the others and is displaced slightly into the gum line. What type of injury is this?
What is an intrusion?
A dog presents with a history of chewing on rocks. You suspect a fractured tooth may be the underlying cause. Radiographs reveal a complicated crown fracture of the right mandibular first molar and a deep periodontal pocket on the mesial aspect of the same tooth. What type of lesion is this, and what is the best treatment approach?
This is likely an endo-perio lesion. Because both periodontal and endodontic involvement are present, extraction is generally the best treatment option.
A client insists that their dog's worn teeth are due to playing fetch with tennis balls, but you suspect attrition. What key piece of information do you need to determine the actual cause of the wear?
What is the dog's occlusion (need to examine how the teeth meet when the mouth is closed)?
Explain how the apical delta in dogs differs from the apical foramen in humans.
In dogs, the apical delta consists of multiple small openings (foramina) that connect the pulp to the periodontal tissues. In humans, there is a single apical foramen.
A dog presents with a fractured upper fourth premolar. Radiographs reveal a fracture line extending below the gum line, but the crown appears intact. How would you classify this fracture?
What is a root fracture?
Describe the pathophysiological mechanism by which blunt force trauma to a tooth can lead to pulp necrosis even without a visible fracture.
Blunt force trauma can cause inflammation and swelling within the pulp, but because the pulp is encased within the rigid dentin, it has no room to expand. This leads to increased pressure within the pulp chamber, compressing the blood vessels and ultimately leading to pulp necrosis.
Explain why it is inappropriate to use specific histological terms like "granuloma" or "abscess" when describing a periapical lesion based solely on radiographic findings.
Radiographs cannot definitively differentiate between different types of periapical lesions. A histopathological examination of a biopsy sample is required to make a definitive diagnosis.
Explain why a root canal is typically required when attempting to save a tooth that has suffered a lateral luxation or avulsion
Luxations and avulsions often disrupt or sever the blood supply to the pulp, leading to pulp necrosis. A root canal is necessary to remove the necrotic pulp and prevent subsequent infection and periapical pathology.
Explain why it can be difficult to determine whether periodontal disease or endodontic disease is the primary problem in a tooth with an endo-perio lesion.
Both conditions can cause similar clinical signs and radiographic changes, and they can exacerbate each other. The presence of a draining tract or fistula often suggests endodontic involvement, but it can also occur with severe periodontal disease.
Explain why it's crucial to differentiate between abrasion and attrition when evaluating a dog with worn teeth.
Identifying the underlying cause is essential for appropriate treatment. Attrition usually indicates a malocclusion that may require orthodontic intervention, especially in younger dogs. Addressing the malocclusion can prevent further wear, gum recession, and periodontal disease.
Describe how "canal calcification" changes the appearance of the pulp cavity on dental radiographs as a dog ages.
As a dog ages, odontoblasts continue to lay down secondary dentin, which narrows the pulp cavity and makes the pulp chamber appear smaller and less radiolucent on x-rays. This normal age-related change is called canal calcification.
True or False: An uncomplicated crown fracture always carries a good prognosis and never requires endodontic treatment. Explain your answer.
While uncomplicated crown fractures do not involve pulp exposure, they can still lead to pulp necrosis and periapical pathology if bacteria gain access to the pulp through the dentinal tubules. Up to 25% of uncomplicated crown fractures may develop periapical lesions.
A dog presents with a discolored, non-vital incisor. The owner declines both root canal therapy and extraction. Under what circumstances might monitoring the tooth be an acceptable option? What are the risks of this approach?
Monitoring may be considered if the tooth is intact (no fracture), there is no evidence of periapical pathology on radiographs, and the owner is committed to yearly rechecks with dental radiographs. Risks include the potential for delayed diagnosis of periapical lesion development, which could necessitate extraction later and may involve more extensive bone loss.
Describe how the inflammatory process associated with pulp necrosis leads to the development of periapical pathology.
When the pulp dies, it breaks down into noxious byproducts that can leak out of the apex of the tooth and irritate the surrounding periodontal ligament and periradicular tissues. This triggers an inflammatory response, leading to bone loss (radiolucency), root resorption, and potentially the formation of a granuloma, abscess, or cyst.
Describe the key steps involved in managing a lateral luxation if the owner elects to try to save the tooth.
1) Take dental radiographs to assess the extent of the injury and rule out root fractures.
2) Clean the affected tooth and surrounding tissues.
3) Reposition the tooth into its correct alignment within the socket.
4) Suture any lacerated soft tissues.
5) Place a wire-acrylic splint to stabilize the tooth during healing.
6) Perform root canal therapy once the splint is removed (typically after 4-6 week
Describe two distinct scenarios that could lead to the development of an endo-perio lesion
Answer: Scenario 1: A dog with severe periodontal disease develops a deep periodontal pocket extending to the apex of a tooth. This can lead to contamination and infection of the pulp through the apical delta, causing pulp necrosis and a periapical lesion.
Answer: Scenario 2: A dog fractures a tooth, resulting in pulp exposure. The resulting infection and inflammation spread from the pulp to the surrounding periodontal tissues, leading to periodontal pocketing and bone loss.